Effect of neonatal perioperative anesthetic exposure in cardiac surgery on neuro- developmental outcomes in preschool children / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the effect of neonatal perioperative anesthetic exposure in complex cardiac surgery on neurodevelopmental outcomes in preschool children.</p><p><b>METHODS</b>General clinical data and data concerning anesthetic exposure were collected from 89 infants undergoing complex cardiac surgery at Sichuan People' Hospital. The cohort was followed for neurodevelopment till preschool age (48-72 months) and assessed with Wechsler Preschool and Primary Scale of Intelligence-III, Beery-Buktenica Developmental Test of Visual Motor Integration (VMI-V), and General Adaptive Composite (GAC) of the Adaptive Behavior Assessment System-II.</p><p><b>RESULTS</b>Seventy-one children were enrolled into the final analysis. Multiple linear regression found days on benzodiazepines (beta;=-0.49, P=0.005) and cumulative dose of benzodiazepines (β=-0.10, P=0.023) were associated with the full-scale IQ in these preschool children. Days on benzodiazepines (beta;=-0.39, P=0.009) and on chloral hydrate (beta;=-1.19, P=0.020) were associated with lower performance intelligence quotient (PIQ) at the preschool age. Cumulative dose of benzodiazepine exposure (beta;=-0.008, P=0.012) was associated with lower VMI scores. No correlations of other sedation/analgesia variables were found with the full-scale IQ, PIQ, Verbal IQ, VMI, or GAC scores.</p><p><b>CONCLUSION</b>We found a significant association of days on benzodiazepines, cumulative dose of benzodiazepines, and days on chloral hydrate in neonatal cardiac surgery with neurodevelopmental outcomes at the preschool age, suggesting the need of minimizing anesthetic exposure during a neonatal cardiac surgery to improve the children's neurodevelopmental outcomes.</p>

Perioperative anesthetic exposure and the neurodevelopmental status of 1 year old baby underwent neonatal cardiac surgery / 中南大学学报(医学版)

OBJECTIVE@#To determine the association between perioperative anesthetic exposure and neurodevelopmental status at age 1 year old baby underwent complex cardiac surgery.
@*METHODS@#One hundred and fifteen infants were selected from Sichuan People's Hospital. A cohort study was conducted on neonates who underwent complex cardiac surgery. The babies were performed brain MRI before the operation and 7 days after the operation, and 12-month neurodevelopmental testing was carried out with Bayley Scales of Infant and Toddler Development (the third Edition, Bayley-III). Doses of volatile anesthetics (VAA), benzodiazepines, and opioids were determined during the 12 months. The association between peri-operative anesthetic exposure and 12-month neurodevelopmental status were analyzed.
@*RESULTS@#A total of 92 infants were enrolled for the final analysis. Their Bayley-III scores of cognitive, language, and movement were as follows: 104.2 ± 14.7, 85.6 ± 11.3, and 86.9 ± 13.5, respectively. MRI results showed that 17 infants showed pre-operative brain injury and 25 infants showed new post-operative injury. After performing the analysis of stepwise multivariable linear regression, MRI showed the factors affecting neurodevelopment of newborn include the new post-operative injury, higher VAA exposure, fentanyl dose, benzodiazepine dose, ICU length of stay, pre-operative mean regional cerebral oxygen saturation (rSO₂), and abnormal chromosomes.
@*CONCLUSION@#VAA exposure and ICU length of stay are associated with poor neurodevelopmental scores at 12 months of age. Further studies need to identify the potential modifiable factors in the peri-operative care of neonates to improve neurodevelopmental outcomes.